A Look into the Future of Endoscopic Submucosal Dissection and Third Space Endoscopy

Chiu, Philip Wai‐Yan; Zhou, Siran

doi:10.1016/j.giec.2022.09.006

Cited by 4 publications

(4 citation statements)

References 79 publications

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“…Future innovations regarding instruments for advanced endoscopic procedures may involve robotic technology. The advantage of the robotic technique is the optimal maneuverability of instrument tips in a small space [52][53][54][55][56][57][58][59]. At first sight, this seems to fit excellently with the small intraluminal space in the gut, which may limit instrument action.…”

Section: Discussionmentioning

confidence: 99%

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The Role of Specialized Instruments for Advanced Endoscopic Resections in Gastrointestinal Disease

Brand,

Fuchs,

Troya

et al. 2023

Life

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Introduction: Advanced endoscopic therapy techniques have been developed and have created alternative treatment options to surgical therapy for several gastrointestinal diseases. This work will focus on new endoscopic tools for special indications of advanced endoscopic resections (ER), especially endoscopic submucosal dissection (ESD), which were developed in our institution. This paper aims to analyze these specialized instruments and identify their status. Methods: Initially, the technical process of ESD was analyzed, and the following limitations of the different endoscopic steps and the necessary manipulations were determined: the problem of traction–countertraction, the grasping force needed to pull on tissue, the instrument tip maneuverability, the limited angulation/triangulation, and the mobility of the scope and instruments. Five instruments developed by our team were used: the Endo-dissector, additional working channel system, external independent next-to-the-scope grasper, 3D overtube working station, and over-the-scope grasper. The instruments were used and applied according to their special functions in dry lab, experimental in vivo, and clinical conditions by the members of our team. Results: The Endo-dissector has a two-fold function: (1) grasping submucosal tissue with enough precision and strength to pull it off the surrounding mucosa and muscle, avoiding damage during energy application and (2) effectively dividing tissue using monopolar energy. The AWC system quickly fulfills the lack of a second working channel as needed to complete the endoscopic task on demand. The EINTS grasper can deliver a serious grasping force, which may be necessary for a traction–countertraction situation during endoscopic resection for lifting a larger specimen. The 3D overtube multifunctional platform provides surgical-like work with bimanual-operated instruments at the tip of the scope, which allows for a coordinated approach during lesion treatment. The OTSG is a grasping tool with very special features for cleaning cavities with debris. Conclusions: The research and development of instruments with special features can solve unmet needs in advanced endoscopic procedures. The latter may help to increase indications for the endoscopic resections of gut lesions in the future.

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Section: Discussionmentioning

confidence: 99%

“…However, endoscopists do use the advantage of the small space by using the narrow gut wall for guidance and to stabilize the position of the scope, which is also important. More clinical experience and technical developments are emerging with the robot systems used in flexible endoscopy [52][53][54][55][56][57][58][59].…”

Section: Discussionmentioning

confidence: 99%

The Role of Specialized Instruments for Advanced Endoscopic Resections in Gastrointestinal Disease

Brand,

Fuchs,

Troya

et al. 2023

Life

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“…Despite that surgical data science has been studied for a while 29 , experimental validation of deep learning models in real-world complex scenarios and/or real-time pre-clinical settings is still extremely limited. Existing literature still lacks systematic experiments on how the developed AI models are validated given various surgeon expertise (e.g., from novices to experienced ones), long-time data expansion (i.e., surgical instruments change over time) and across surgical sites (from retrospective human data to ex vivo/in vivo animal trials).…”

Section: Introductionmentioning

confidence: 99%

Intelligent surgical workflow recognition for endoscopic submucosal dissection with real-time animal study

Cao,

Yip,

Chen

et al. 2023

Nat Commun

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Recent advancements in artificial intelligence have witnessed human-level performance; however, AI-enabled cognitive assistance for therapeutic procedures has not been fully explored nor pre-clinically validated. Here we propose AI-Endo, an intelligent surgical workflow recognition suit, for endoscopic submucosal dissection (ESD). Our AI-Endo is trained on high-quality ESD cases from an expert endoscopist, covering a decade time expansion and consisting of 201,026 labeled frames. The learned model demonstrates outstanding performance on validation data, including cases from relatively junior endoscopists with various skill levels, procedures conducted with different endoscopy systems and therapeutic skills, and cohorts from international multi-centers. Furthermore, we integrate our AI-Endo with the Olympus endoscopic system and validate the AI-enabled cognitive assistance system with animal studies in live ESD training sessions. Dedicated data analysis from surgical phase recognition results is summarized in an automatically generated report for skill assessment.

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“…Endoscopic submucosal dissection (ESD) technique has gained popularity and has been adopted for various procedures such as endoscopic myotomy or third space endoscopy for the treatment of gastrointestinal diseases. 1 A major concern regarding the widespread use of ESD technique is that the “Master-Apprentice process” is still a basic step for familiarizing with this procedure. This apprenticeship-based training method is highly beneficial for endoscopic training and remains the cornerstone of the gastrointestinal endoscopy training method.…”

mentioning

confidence: 99%

There is no royal road: a shortcut for endoscopic submucosal dissection training

Jeon

2023

Clin Endosc

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A Look into the Future of Endoscopic Submucosal Dissection and Third Space Endoscopy

Cited by 4 publications

References 79 publications

The Role of Specialized Instruments for Advanced Endoscopic Resections in Gastrointestinal Disease

The Role of Specialized Instruments for Advanced Endoscopic Resections in Gastrointestinal Disease

Intelligent surgical workflow recognition for endoscopic submucosal dissection with real-time animal study

There is no royal road: a shortcut for endoscopic submucosal dissection training

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